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removal of a feeding tube, would inevitably lead to his death. The feeding tube, as in the
earlier case of Nancy Cruzan (1983), was determined to represent disproportionate rather
than proportionate means of treatment (benefits versus burdens).
The Goldman case likewise is complex, but for different reasons. The patient
was not terminally ill with six months or less to live, nor was she in a PVS. Mrs.
Goldman's desire to refuse all treatment in the face of a diminished quality of life in our
view represents a misunderstanding of the distinction between proportionate and
disproportionate treatments to preserve life. That distinction does not to uphold a "right
to die" but a "right to let die." Self-determination is not absolute. The court's finding
reflects the spirit of this principle by requiring non-invasive treatments to continue.
The second part of the decision is more difficult to analyze. In Mrs. Goldman's
case the court determined that any argument in favor of invasive treatment was too weak
so as to overcome autonomy. We see here a concern to uphold the sanctity of life while
showing mercy in the face of severely diminished capacity. Is it merciful to refrain from
mandating invasive treatments based on the patient's diminished capacity (quality of
life)? Where does our concern for the sanctity of life end and the desire to promote a
"good death" begin? When should such a patient be treated as a disabled person (not
terminally ill) and when does the condition deteriorate to the place where it can be
considered a "fatal pathology?"
We need to weigh this decision carefully. Like Fiori, the court was willing to
accept a substituted judgment with respect to what it considered disproportionate
treatment. But since Mrs. Goldman was not in a PVS nor terminally ill, is the finding
consistent with the balance between the sanctity of life and the reality of death?